Kaiser Sued Over Access To Mental Health Benefits

On October 3, 2013, a lawsuit seeking class-action status was filed against the Kaiser Foundation Health Plan (“Kaiser”) in California by three plaintiffs who allege on their own behalf and on behalf of potentially thousands of other patients that Kaiser is failing to properly treat patients with mental illness by systematically denying them timely access to mental health services.

The lawsuit alleges that Kaiser contributed to the death of at least one Kaiser member who committed suicide and that Kaiser forced at least two other members to seek mental health care outside of Kaiser’s health plan that cost them thousands of dollars out of their own pockets.

A Kaiser member wrote after she read about the lawsuit, “Kaiser denied me weekly individual psychotherapy even though I am suicidal. I’ve been forced to hold an online fundraiser to pay for therapy outside of Kaiser. Kaiser’s own informational materials previously indicated that they simply don’t offer long term individual therapy (before the state cited them for that). Now they don’t say it but it’s still what they practice.”

In response to the filing of the lawsuit, a Kaiser spokesperson stated that the law firm that filed the lawsuit has represented the National Union of Healthcare Workers in the past and that the Union is attempting to cast Kaiser in a negative light in the lawsuit while a contentious labor dispute between them continues.

On June 25, 2013, the California Department of Managed Health Care (DMHC) announced that it issued a $4 million fine against Kaiser Foundation Health Plan for four serious deficiencies in providing access to mental health services. Those deficiencies alleged that Kaiser does not: (1) ensure that its quality assurance systems accurately track, measure, and monitor the accessibility and availability of providers; (2) sufficiently monitor the capacity and availability of its provider network to ensure that appointments are offered within the regulatory timeframes; (3) ensure that effective action is taken to improve care where deficiencies are identified; or (4) provide accurate and understandable mental health education materials, including information regarding the availability and optimal use of mental health care services provided by the plan.

DMHC also determined that Kaiser’s mental health educational materials, including “Frequently Asked Questions” (FAQ) sheets, Web site postings, and new patient presentations, included inaccurate information that could dissuade a member from pursuing medically necessary care. DMHC found examples of member materials that, while consistent with the law, did not convey coverage in language understandable to the average member.

In announcing the fine, DMHC’s Director stated, “The Department’s actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them. The Department is taking this action to ensure that Kaiser promptly corrects these deficiencies and provides its patients with the mental health care promised to them by their health plan.”

DMHC promised to conduct a follow-up survey in October 2013 to ensure that Kaiser has corrected each of the deficiencies and is complying with the law.

If you or a loved one were denied mental health benefits or suffered injuries or other harms as a result of mental health care in California or in another U.S. state, you may click here to visit our website to be connected with medical malpractice lawyers in California (or medical malpractice lawyers in your state) who may investigate your mental health claim for you and represent you in a mental health malpractice lawsuit, if appropriate. You may also reach us on our toll-free line: 800-295-3959.